In a 6-3 ruling, the Court found that premium subsidies should be available both in states that have set up their own health insurance exchanges, and in states that use the federal exchange, like West Virginia.

The plaintiffs in King vs Burwell case contended that the under the law, premium subsidies should only be available in states with their own exchanges, not to those enrolled through the federal exchange. This argument was supported by a number of conservative politicians, including West Virginia's Attorney General Patrick Morrisey.

However, the Court rejected that argument, making subsidies available in all states, marking the second time the Supreme Court has upheld a key Affordable Care Act Provision.

West Virginia is one of 36 states using the federal exchange rather than setting up its own exchange. Had the Supreme Court's ruling gone the other way, West Virginians in the federal exchange would have lost their premium subsidies, in some cases tripling the cost of health insurance.

The are approximately 33,000 people enrolled in health insurance plans through the exchange in West Virginia, with about 25,000 qualified for premium subsidies. In 2014, those with subsidized exchange plans in West Virginia saw their monthly premiums reduced from $415 to just $113, meaning that 78% of premium costs are covered by subsidies. At that rate, in 2016 the subsidies could save low and moderate income West Virginians over $185 million.

Since the enactment of the Affordable Care Act, West Virginia's uninsured rate has plummeted from 17% to 6.6%, almost entirely due to the law. With the Supreme Court's ruling today, that progress in insuring West Virginia's population has been protected and the destabilization of the individual market has been prevented, and West Virginia remains one of the biggest Affordable Care Act success stories.

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